Healthcare Provider Details

I. General information

NPI: 1710135306
Provider Name (Legal Business Name): MOUNTAIN RIVER PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5479 POTTSVILLE PIKE SUITE 200
LEESPORT PA
19533-8650
US

IV. Provider business mailing address

415 36TH ST SUITE 100
PARKERSBURG WV
26101-1005
US

V. Phone/Fax

Practice location:
  • Phone: 610-926-6778
  • Fax: 610-926-7200
Mailing address:
  • Phone: 304-917-3660
  • Fax: 304-917-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BURTON REED
Title or Position: OWNER/THERAPIST
Credential: PT, OCS, FAAOMPT
Phone: 304-865-6778